Cognitive Therapy Case Conceptualization
The client: Elena Elena is an adolescent female, coming to the therapy process demonstrating through actions and words a great deal of anxiety and overall apathy for her situation. Elena is a smart, socially engaged Mexican American attending public high school. She opens the session with presenting problems regarding conflict over what she might do after high school. Preliminary conceptualization from a cognitive perspective Overall, there is an obvious feeling of disempowered regarding her right and or ability to make life decisions.
She comes from a close-knit family, though some of her siblings have moved away to seek out goals beyond those that they may feel their parents are putting upon them. She has recently begun to disengage academically and socially as she feels the urgency of choosing to adhere to family tradition or to go out on her own, like her peers. Though she says she has not yet made a decision, know that cognition mediates affect and behavior (Friedburg 101).
From this perspective a therapist might conclude that her recent apathy toward academics and isolating herself from her peers show that she indeed is letting the thoughts of “I must listen to my parents” drive her life perspective. It is promising from a cognitive standpoint, that she shows some jealousy toward her boyfriend and others: Perhaps the anger when discussing her family dynamics and recent history is most telling that Elena could benefit from Beck’s Socratic dialogue.
The pluralistic views that come from her own identity within her biculturalism are strongly embedded, and the therapist demonstrated this by demonstrating lots of open questions. Letting Elena focus on herself as an individual rather than a Mexican-American could lead to meaningful exploration and collaborative cognitive change to help Elena feel more empowered.
When counseling adolescents from a cognitive perspective the counselor must remember that under any circumstances this may be the first time that these clients might see their actions and behaviors, and question the beliefs that may have become embedded during childhood. Elena obviously needs a relatively short-term look into these feelings due to her grades slipping and applying for colleges, if she so chooses. Asking a client “what is going through your mind right now” (Murdock 337) is one of the base approaches to beginning to help the client recognize their individual thought patterns.
This is a question that is difficult for many adults, and though adolescents in general can be more open to change, Elena’s worldview as a bicultural young woman is overpowering any other automatic thoughts that she might have; it is culturally appropriate for a young Mexican American to disregard her own thoughts and needs for the good of the family—which Elena does in fact voice (Rochlen 2009). As an observer to this case scenario, the challenge, due to age and culture, seems very difficult. The video demonstrates this strong schema Elena has developed that exudes this overwhelming disempowerment.
I believe this schema of overall disempowerment is deeply embedded and will be difficult to challenge through cognitive therapy. Additionally, Mexican culture tends to see the counselor as “expert” and the collaborative aspect of cognitive therapy may prove to be at the least uncomfortable for Elena, if not ineffective. Elena may continue to rely on others’ to make decisions for her, to give her an unconditional guarantee (Corey 107), if this base belief cannot be penetrated due to adherence to cultural tradition, fear of change, or if Elena is unable to begin to identify these automatic thoughts. Possible cognitive strategies
In general, Latino Americans traditionally have strong family bonds and honor generational wisdom (Sue 377) Through the current political venue of the United States and popular culture, Mexican-Americans may fall prey to stereotypes and inherently feel a disconnect or poor self-image: American beliefs certainly account for this inner struggle Elena is feeling. Because this is pervasive and overarching in American culture where to begin with Elena in imperative. There is a lot behind these feelings, and as an adolescent who is struggling the counselor should take these omnipresent cultural truths into consideration.
It is promising to me that Elena is already speaking about her siblings: I see this as an open door for initiating questions that challenge Elena’s view of herself as a young Mexican American. I would certainly recognize Elena’s frustration and give lots of positive regard as she speaks about her presenting problem. Cognitively, I would go back to Elena’s conversation regarding the varying paths her siblings have chosen. I would respectfully move through this aspect of cognitive therapy so as to not threaten Elena’s loyalty to her family.
Since Beck’s model is based on a leading rather than a more confrontational approach, I would use this to my advantage to allow her to explore her emotions about her siblings and their life choices. I see this as an aspect of Elena’s life experience that may allow Elena to begin to explore self-identity outside of the effects of biculturalism. Keeping the central focus of thought exploration on how she might challenge her beliefs about her life choices through reflecting on her siblings’ life choices may be a safe way to allow Elena to begin connecting the deeper thoughts behind her ability to make life choices.
From a cognitive perspective and the lens of cultural identity, my goal for Elena would be for her to begin understanding that many are facing overwhelming decisions within their own cultural context. At some point everyone must decide to respect family wishes or go out on her own. Elena would be challenged to explore the beliefs she holds regarding herself as a Mexican American; she could begin to see how the complex construct is not a means to an end. Helping Elena expose automatic thoughts and change subsequent behaviors could serve to identify the struggle she will face as a bicultural woman in America today.
Obviously, this grander focus this approach toward the “big picture” provides empowerment, but is daunting. Collaboratively, it would be ideal to praise Elena for exploring her identity on a grander scale. At this point, I would encourage Elena to do some homework: Her recent social isolation undermines her support system and exploration of self-identity. Many of her friends to do not sound as if they are struggling as bicultural adolescents: Meeting with a Latino cultural group on her local college campus would be an ideal way to allow her to feel empowered as well as supported.
I am sure that many others have faced this kind of multicultural dilemma in their formative years, and have come up with myriad life choices. Though I can help Elena begin to understand and possibly question her core beliefs that drive her behaviors, she will need safe and pertinent ways to explore them. Elena is a very intelligent young lady, and I do think from our observation that she inherently knows that as well.
Finding places and people with whom she can identify will empower her—not pressuring her into making a decision about her next step in life; with a goal toward hearing other stories of biculturalism in America and give her a comfortable place to explore her wishes for her own future and how she might find congruency between her choices and her heritage. I am certain that once her belief of what it means to be Mexican-American is challenged in some authentic way, she will begin to explore her automatic thoughts about cultural identity.
My hope in working with Elena from a cognitive perspective is that she will begin to see her own identity and realize how her own thoughts had created a situation that most certainly is not the only possible scenario for her path in life. Relevant multicultural considerations From the perspective of a bilingual educator and a culturally aware individual, I was ultimately unable to separate Elena’s biculturalism from the cognitive approaches and questioning that I would practice with Elena.
Though this aspect of Elena’s life situation appears hopeless to her now, I believe through finding authentic ways to identify with successful, independent Mexican-Americans she might begin to expose the prevailing automatic thoughts leading her to these isolating, dichotomous conclusions. The last relevant multicultural aspect that I have not addressed is it would be imperative that I find an opportunity to speak with Elena’s family, and connect them with other families who are raising children in a bicultural environment.
This is ideal because Latino families need opportunities to be involved in the community and support one another in myriad ways. non-productive cognitive approaches Note how at the beginning of this integrated discourse regarding Elena’s pull toward family tradition and sense of loss for her dreams of going to college I was careful to note which door felt safe and respectful to collaboratively open with Elena.
Siblings, cousins, aunts and uncles may “stay out of family business” such as the pressure from her mother, but it would be culturally insensitive for me to have Elena challenge her thoughts and risking her attaching them to family ties. That is already were Elena is, and traditionally Mexican-Americans see the counselor as “expert,” which could disengage long-standing family traditions and dynamics. I am convinced that approaching Elena through questions about herself, her riends, her academic life, and family would have made her feel that cognition is knowable and accessible, which is an underlying foundation of Beck’s theory. If a counselor were to solely base their approach, without multicultural considerations, on cognitive therapy with Elena as an individual it could serve to not allow herself to fully feel her human emotions, nor to bring awareness that change is central to the human process.
I do not think asking Elena to explain how her beliefs construct her reality without first finding meaningful ways for her to relate to others outside of herself could she effect any change at all. Cognitive therapy, through the lens of multiculturalism, must always consider the bigger picture of what their life perspective really is: If challenged directly about her mother Elena may have only further solidified her commitment to fail at school to have a concrete reason to obey her parents.
